"More and more, dental and other healthcare professionals will be required to collaborate to create teams dedicated to the management of people with diabetes at both the community and patient levels, given the interactions between oral inflammation and the comorbidities associated with diabetes," wrote lead study author Anthony Iacopino, D.M.D., Ph.D. (Canadian Journal of Diabetes, September 2009, pp. 146-147).
The authors noted that 75% of diabetics also have gingivitis and periodontitis.
"Yet it also goes without saying that by providing dental care to improve both 'oral' and 'systemic' health, healthcare professionals must remember that 'health is health' and 'disease is disease,' regardless of anatomical location," the authors pointed out.
Don Friedlander, D.D.S., an Ottawa, Ontario, dentist and president of the Canadian Dental Association (CDA), notes that oral health is a component of overall health.
"What we're beginning to understand more and more are the linkages with good general health," he told the Vancouver Sun. "Correlations and associations have been found between poor oral health and many systemic diseases such as cardiovascular disease, diabetes, respiratory problems, and preterm births."
Robert MacGregor, D.D.S., a Nova Scotia dentist and vice president of the CDA, says that in addition to the connection between oral and heart health, "recent research shows that people with oral bacteria and periodontal disease seem more prone to respiratory illness and having babies with low birth weights. And it has long been known that uncontrolled diabetes can lead to aggressive periodontal disease and vice versa," according to the Sun story.
Many chronic inflammatory diseases and conditions have been shown to share common physiological and biochemical bases (especially periodontitis and diabetes), including related underlying pathophysiological mechanisms and risk factors, according to the study authors. "Indeed, the risk factors for cardiovascular disease (a major complication of diabetes) and periodontitis are virtually identical," they wrote.
The researchers noted that diabetes predisposes patients to oral infection, and once the infection is established, it exacerbates diabetes-related hyperglycemia and may even predispose otherwise healthy individuals to develop diabetes.
Patients with diabetes have elevated serum levels of low-density lipoprotein cholesterol and triglycerides (even when blood glucose levels are well-controlled), and these can alter immune cell function via the upregulation of proinflammatory cytokines and downregulation of growth factors, Dr. Iacopino wrote.
This predisposes diabetics to chronic inflammation, progressive tissue breakdown, and diminished tissue repair -- a process that is critically important for periodontal tissues, which are under continual assault by substances emanating from oral biofilms. Hence, periodontitis is more severe and rapidly progressive in people with diabetes compared to people without diabetes, the researchers concluded.
Additionally, periodontitis induces general increases in systemic inflammation and even insulin resistance, along with the potential to destroy pancreatic beta cells. Perhaps this explains why periodontitis has a deleterious effect on diabetes-induced hyperlipidemia, immune cell function, tissue repair, and glucose metabolism, the study authors found.
Studies have shown that when periodontitis is treated, diabetes disease parameters improve.
"All healthcare professionals must recognize that there is no 'trap door' at the mouth," the authors warned. "Oral health is one constituent of general health, existing within the health-disease continuum and requiring attention by all healthcare professionals. Indeed, there is no better model for the concept of interprofessional care than the diabetes-periodontitis axis."
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